Key Takeaways

You might say it feels like pins and needles, a tingling, or as if a hand has gone to sleep.

While people with rheumatoid arthritis (RA) often experience these signs of numbness, especially in their hands, the sensations are not directly related to rheumatoid arthritis. Sometimes these symptoms are related to an RA complication: carpal tunnel syndrome, a painful condition caused by compression of the median nerve, which runs from the wrist to the fingers.

Carpal tunnel syndrome is somewhat common among those with RA; as many as 5 percent of people with RA will develop it.

So what's the connection?

Think of it as a cascade or domino effect: A person has RA in her wrist and inflammation develops, which can lead to swelling in the lower arm or hand. Together, the inflammation and swelling increase pressure on the median nerve. Over time, the median nerve is compressed to the point that it partially or completely blocks the nerve and the impulses traveling through it. This can result in a mild to severe tingling, burning, or a numb feeling, as well as weakness, a loss of sensation, or even — in extreme cases — a loss of function.

Location: Where do you feel numbness, specifically? In your wrist, palm, or certain fingers?

Timing: How frequently do you feel it? Is it sustained, or does sensation come and go?

Duration: How long do numbness episodes last?

Typical circumstances: Do you feel it more when you do certain activities, such as driving, typing, texting, or using a hair dryer?

Your rheumatologist might diagnose and treat you, or send you to a neurologist or orthopedic surgeon who specializes in treating such issues in the hands.

Carpal tunnel syndrome diagnostic tools include:

X-rays or an ultrasound

An electromyogram, which measures the electrical activity of your muscles during contraction and relaxation

A nerve conduction study: a shock test that uses electrodes to find out whether electrical impulses slow down when they're in the carpal tunnel

There are many different treatment options for RA-related carpal tunnel syndrome, according to Dr. Ruderman, and the majority of people who experience this complication can find relief. Treatment choices largely depend on the severity of the numbness.

A doctor might have you wear a wrist splint at night, for example, or get a steroid injection, or change the dosage or type of RA medication you're on (if your RA isn't well-controlled). In rare, severe cases, surgery may be necessary: A surgeon could cut the ligament that runs over the top of the carpal tunnel, giving the swelling a place to go and relieving some of the constant nerve pressure.

It's best to treat carpal tunnel syndrome early, whether you have rheumatoid arthritis or not. There’s no reason to live with the pain. Untreated, carpal tunnel problems may lead to muscle atrophy and weakness in your hand, and less dexterity in your fingers. In rare cases, the median nerve can become permanently damaged.